To compare the outcomes of orthotopic and heterotopic ovarian tissue transplantation techniques.
Mixed Prospective-Retrospective cohort study SUBJECTS: 14 recipients of autologous ovarian tissue transplantation INTERVENTIONS: Of the 14 women, 12 who received orthotopic (n=6) or heterotopic (n=6) transplants met the inclusion criteria. All orthotopic transplants and one heterotopic ovarian tissue transplant were performed laparoscopically. While five of six remaining heterotopic transplants were performed subcutaneously under local anesthesia or iv sedation, one was performed with robotic assistance. With the exception of one recipient who solely desired restoration of endocrine function, all underwent oocyte retrieval either to cryopreserve oocytes/embryos before the graft function ceased or because they could not otherwise conceive (hysterectomy, radiation damage, heterotopic transplant).
Primary outcome measures were graft function and longevity, and number embryos generated per retrieval.
The mean age at ovarian tissue harvesting and at transplantation was lower in the orthotopic vs heterotopic transplant patients, (p<0.001 and p=0.03, respectively) while the proportion of transplanted ovarian cortex was lower in heterotopic transplant cases (p=0.003). All grafts restored ovarian endocrine function. Fertilization rates, the number of embryos generated per retrieval and the mean number of non-arrested embryos were significantly lower in the heterotopic ovarian tissue transplantation (p=0.002, p=0.004 and p=0.01, respectively). However, time to function and graft longevity were similar between the groups. While four of six women conceived and delivered seven children among orthotopic ovarian tissue recipients, one recipient had three spontaneous livebirths after heterotopic ovarian tissue transplantation, presumably due to the induction of function in the remaining menopausal ovary.
It appears, orthotopic ovarian tissue transplantation results in higher gamete and embryo quality. However, endocrine function restoration rate and longevity are similar between the two approaches. When feasible, orthotopic ovarian tissue transplantation should be preferred for those who intend to conceive, while a less invasive heterotopic ovarian tissue transplantation can be performed for those who primarily desire ovarian endocrine function.

Copyright © 2023. Published by Elsevier Inc.